23810245 reading rehabilitation 11-13-08
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Reading
Rehabilitation
Implementing Patient-Focused Care
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Reading Rehab Hospital Roots
HealthSouths RRH Facility Built in 1925 the historic
Stone Manor on a 30-acre campus.
The million dollar home.
Was originally the homeof Isaac Eberly, aprominent businessman
and hosiery mogul.
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Leading Change
Clint Kreitner: CEO of RRH from 1989-2000
History:
Early career as a Naval officer
Respected entrepreneur with 4 successfulcompanies
On board of RRH for 3 years
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Kreitners Forecast
Kreitner: The hospital had an awesome reputation, adedicated staff, and no debt.
Instincts: his insight of business told him that RRH was
headed for difficult times Reasons:
Over 50% of RRH referels came from one large hospital Industry was inflicting double digit annual increases on the U.S.
economy
Action: He began forums with the staff to communicate need for change Opened the financial books to the staff to show them what he saw
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Staff Reaction
This type of communication was a first for RRHand not typical for that industry.
It made many of the staff feel uncomfortablebecause they had been in a thriving industry for15-20 years and did not want to believe theywere in trouble.
Needless to say, his opinion was not universallyshared due to his lack of healthcare industryexperience.
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Rehabilitation Services
Brief History of RRH from 1958 to present In 1998 RRH had 76 beds, 116 therapists and 25 million in
revenue Most patients came to RRH after treatment of an illness or injury
at an acute care hospital Rehab hospitals restore basic functioning, such as walking,
climbing stairs, getting dressed, and feeding oneself Used Functional Independence Measures (FIM's) Goal was to help patients leave functioning as independentely as
possible
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Rehabilitation Services RRH, like other rehab hospitals, also differed from acute care hospitals in being smaller than
most of them. RRH's annual revenues of $25 million compared to more than $200 million for the largest and
$45 million for the smallest acute care hospital in its region RRH admitted patients with a wide range of diagnoses
Head injury Stroke Spinal cord injuries Orthopedic problems
Received care from 5 disciplines Physiatrists (rehab dr.) Nurses Social workers Physical therapists Occupational therapists
If patient had head injury or stroke: Psychologists Cognitive therapists Speech therapists
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Effectiveness
Measured effectiveness by using three dimensions: Average length of stay Increase of functional outcomes Patient satisfaction
Average length of stay compared favorably to the national averagewhich was 21 days Achieved nearly the same increase in the level of functional
independence Patients were more satisfied with quality of care at RRH compared to
national benchmark)
Patient care declined over the next 8 years This was due to shorter lengths of stay rather than due to fewer patients Fewer patient days = Less revenue
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Mission
Mission of Reading Rehabilitation As a subsidiary of Adventist Health Ministries, Inc, Reading
Rehabilitation Hospital was a non profit organization inPennsylvania.
The well being of the patient is the number one priority of theRRH, together with its sister companies.
Because of the centers affiliation with the Adventist church,commitment to the patients well being became stronger.
The mission of the Reading Rehabilitation center did not limititself to the physical healing, but spiritual healing as well.
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Purpose
The organizations values, as well as strategicand operational decisions were also base on thisvision.
The mission and vision of ReadingRehabilitation Hospital was put at a test due tothe competitive world of health care.
As mentioned by Kreitner, the CEO brought in
since 1989, finding balance between missionand real world business practice was one of thegreatest challenges faced by Reading Rehab.
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Pressures from Managed Care 1980s and 1990s healthcare costs were escalating out of control
with adverse consequences for both the federal budget and U.S.corporations.
The government responded with changes to Medicare and Medicaid.
In 1983, Medicare introduced a Prospective Payment System (PPS)under which standard payments were made based on a patientsdiagnosis, regardless of the institutions actual cost.
Medicaid, funded through state budgets, declined in funding over the
1980s and 1990s, reducing the level of reimbursements.
One of the most significant innovations affecting the U.S. healthcareindustry was the rapid emergence of managed care.
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What is Managed Care?
The term managed care is used to
describe a variety of techniques intended
to reduce the cost of providing healthbenefits and improve the quality of care.
According to the National Library of
Medicine, managed care encompassesprograms.
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Main Purpose:To reduce unnecessary health care costs through a varietyof mechanisms such as:
Programs for reviewing the medical necessity of specific services
Increased beneficiary cost sharing
Economic incentives for physicians and patients to select less costly forms of care
Controls on inpatient admissions and lengths of stay
Selective contracting with health care providers
Intensive management of high-cost health care cases
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Fee-for-Service (FFS)
Until 1980s private health insurance plans allowed patientsto choose their own doctors.
Under this fee-for-service (FFS) model, the role of theinsurance company was simply to pay the bills.
Doctors were free to prescribe any treatment consistent with acceptedmedical practice and to determine fees for such treatment.
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Change This all changed in 1980s with new state laws that allowed
insurance companies to negotiate prices directly with health careproviders.
In attempt to reduce costs
Managed care organizations (MCO) adopted a more business-likeapproach for delivering care.
The idea was to get doctors and hospitals under contract atdiscounted prices and then control the use of services by managedcare health plan members.
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What would happen
Patients would choose from a predetermined listof participating doctors, a primary care physician
(PCP) who served as the gatekeeper for thepatient.
These changes meant that hospitals had toperform tasks more efficiently so costs did notexceed payments received from MCOs.
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Reading Rehabilitation Hospital Acute Rehabilitation hospitals like RRH were cushioned
from some of these changes in the healthcaresystemat least for the time being!
Most RRH patients were on Medicare, and the more
generous the Medicare rate was, the more advantage itwas for the Reading Rehabilitation Hospital. Kreitner noted, At times, we would keep patients twice
as long as we do, and get reimbursed for it. But we cant afford to get lazy. So we strive to keep
costs down and maximize incentive pay, rather thanmaximizing the reimbursement.
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Main Goal
RRH (Reading Rehabilitation Hospital) was at advantage because they
would keep patients longer and they would get reimbursements
Prospective Payment System did not force them to lower their cost becauseMedicare would pay the difference between average cost and what their limit was
TO MAXIMIZE INCENTIVE PAY
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Competition
Reading Rehabilitation HospitalOnly acute rehab in Pennsylvania market
Accounted for about 6% of market share
Shared the market with 3 acute care hospitals
Reading Hospital & Medical Center (RHMC): 57% St. Josephs Medical Center: 24%
Community General Hospital: 13%
Upstream acutecare hospitals
RehabilitationHospitals
DownstreamOrganizations
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Patient Flow
Local Acute Care Hospitals
Trauma Centers
Physicians (home/nursing homes)
Incoming Patients
Discharged Patients
Home
Nursing homes
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Continuum of Care
Acute care hospitals kept patients longer
Create new efficiencies and fill empty beds
Traditional nursing homes began offeringmany rehab services
Rehab expansion of other industryparticipation would have a negative effecton RRH
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Market Conditions
RRH = only licensed provider of acute rehabservices in Berks County
RHMC tried to buy RRHs licenseClint Kreitner valued it at $6-$8 Million
Pennsylvania Regulations required Certification ofneed (CON) before granting license for new acute
rehab service CON limited rehabs services others could provide
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Market Conditions
Increasing competition in product market
Highly competitive labor market
Occupational Therapists Physical Therapists
Unfavorable Supply/Demand
Kreitner: We constantly live in fear that our therapists
will bail out en masse and as a result, theorganization will be brought to its knees.
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The Rehabilitation Process
Admission from upstream providers
Care providers from multiple discipline
evaluate patients Weekly conference involving interaction
between the patient and care providers
Integrated plan care Discharge
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The Rehabilitation Process
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Process Improvement
Kreitner assumed Leadership
Patient care across disciplines ineffective
Delay in treatment and inconsistency amongtreatments
Kreitner Implemented Continuous ImprovementInitiative
Kaizen Effect Process
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Process Improvement
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Process Improvement (Barriers)
Issues impacting the process improvement
Staff disciplines cannot cross train
Staff could not be in ready statusPatient severity was not known in advance
Shorter length of stay, immediate need to the
discipline
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Performance Improvement
(Barriers) Variance in patient acuity leads to
scheduling problems
Service lines are not flexible for the shortlength of stay
Medicare reimbursement is driven to the
therapy target loss of revenue
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Staffing Barrier Specifics
COP for CMS Requirements for IRF
Daily access to Physician
24 hour nursingMinimum 3 hours per day/5 days
Two forms of therapy available
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Reading Rehabilitation Hospital:
Where are they now? Acquired by HealthSouth Corp in 1998
One of multiple purchases in the 1990s Others included NovaCare, Columbia/HCA Mix of facilities, including acute care rehab
Not unlike RRH, faced challenges due to changing reimbursementlandscape Medicare Balance Budget Act Managed Care Organizations
Succeeded in maintaining, then increasing revenue projections Diversification Capturing market share (simultaneously solving RRH volume problem)
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Changes in Organization Model
Prior to sale, RRH returned to the departmental structure Staffing efficiencies returned Issues relation to patient care addressed via better process coordination
As HealthSouth, RRH continues to use this model, now lead by a primarynurse
24-hour team of registered nurses and personal care assistants assess andattend to each patient's needs. They work in partnership under the primarynurse-model, which assures continuity of care.
Although time-limited twice weekly conferences were piloted, weeklyinterdisciplinary team meetings have been adopted under HealthSouth
Each week your treatment team will meet to discuss your progress, goals and dischargeplan.
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Continued Growth and Success
The HealthSouth Reading Rehabilitation Hospital has expanded to offer Inpatient Rehabilitation Outpatient Rehabilitation Home Heath Care Service
Continues to demonstrate high levels of patient satisfaction, as evidencedby higher than average ratings in two important measures: Would You Recommend
Overall Quality of Care.
Utilizes an Outcomes Measurement tool to track each patients functioning
both upon admission and after treatment
Uses such data to benchmark outcomes and ensure programs are meetingpatient rehabilitation needs
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Reading Rehab Group:
Jimmie Olazaba Stacey Benson Anemone Basabakwinshi Tahira Raza Ailiya Raza Quynh Smith
Charles Workman Kenith Causey Grace Cruz
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References
Commitment Quality. Retrieved November 7, 2008, from HeathSouthReading Rehabilitation Web site:http://www.healthsouthreading.com/quality_commit.asp
Frequently Asked Questions. Retrieved November 7, 2008, from
HeathSouth Reading Rehabilitation Web site:http://www.healthsouthreading.com/quality_commit.aspGittell, J.H (1999). Reading Rehabilitation Hospital: Implementation
Patient-Focused Care, Teaching Note. Harvard Business Review,5(899-139), 1-16.
Managed Care. Medline Plus. Retrieved November 4, 2008, from
http://www.nlm.nih.gov/medlineplus/managedcare.htmlManaged Care. Retrieved November 4, 2008, fromhttp://en.wikipedia.org/wiki/Managed_care
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